Non-specific pain and 30-day readmission in acute coronary syndromes: findings from the TRACE-CORE prospective cohort

Jinying Chen; Catarina I Kiefe; Marc Gagnier; Darleen Lessard; David McManus; Bo Wang; Thomas K Houston

doi:10.1186/s12872-021-02195-z

Non-specific pain and 30-day readmission in acute coronary syndromes: findings from the TRACE-CORE prospective cohort

BMC Cardiovasc Disord. 2021 Aug 9;21(1):383. doi: 10.1186/s12872-021-02195-z.

Authors

Jinying Chen¹, Catarina I Kiefe², Marc Gagnier³, Darleen Lessard², David McManus⁴, Bo Wang², Thomas K Houston⁵

Affiliations

¹ Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA. jinying.chen@umassmed.edu.
² Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
³ UMass Memorial Health Care, Worcester, MA, USA.
⁴ Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
⁵ Wake Forest School of Medicine, Winston-Salem, NC, USA.

Abstract

Background: Patients with acute coronary syndromes often experience non-specific (generic) pain after hospital discharge. However, evidence about the association between post-discharge non-specific pain and rehospitalization remains limited.

Methods: We analyzed data from the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE) prospective cohort. TRACE-CORE followed patients with acute coronary syndromes for 24 months post-discharge from the index hospitalization, collected patient-reported generic pain (using SF-36) and chest pain (using the Seattle Angina Questionnaire) and rehospitalization events. We assessed the association between generic pain and 30-day rehospitalization using multivariable logistic regression (N = 787). We also examined the associations among patient-reported pain, pain documentation identified by natural language processing (NLP) from electronic health record (EHR) notes, and the outcome.

Results: Patients were 62 years old (SD = 11.4), with 5.1% Black or Hispanic individuals and 29.9% women. Within 30 days post-discharge, 87 (11.1%) patients were re-hospitalized. Patient-reported mild-to-moderate pain, without EHR documentation, was associated with 30-day rehospitalization (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.14-3.62, reference: no pain) after adjusting for baseline characteristics; while patient-reported mild-to-moderate pain with EHR documentation (presumably addressed) was not (OR: 1.23, 95% CI: 0.52-2.90). Severe pain was also associated with 30-day rehospitalization (OR: 3.16, 95% CI: 1.32-7.54), even after further adjusting for chest pain (OR: 2.59, 95% CI: 1.06-6.35).

Conclusions: Patient-reported post-discharge generic pain was positively associated with 30-day rehospitalization. Future studies should further disentangle the impact of cardiac and non-cardiac pain on rehospitalization and develop strategies to support the timely management of post-discharge pain by healthcare providers.

Keywords: Acute coronary syndrome; Cardiovascular disease; Care transition; Electronic health records; Natural language processing; Non-specific pain; Readmission.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural

MeSH terms

Acute Coronary Syndrome / complications*
Acute Coronary Syndrome / ethnology
Aftercare
Aged
Chest Pain / etiology*
Electronic Health Records
Female
Hospitalization
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Patient Discharge
Patient Readmission / statistics & numerical data*
Prospective Studies

Abstract

Publication types

MeSH terms

Grants and funding